HongyuanCounryRupidossessment Sumet'
Ilongvnurr CountyRupid dss.rsnutt SurncJ
V H C c o l l e c t e d d a t a n r a y b e l o s t . I f , a s w a s s u g g e s t e da t t l l e W & C , c e n s u sd a t a i s c o l l e c t e d by PHB/W&C staff, Tibetan nornadic nrothers would seern unlikely to give vital infbrntation to unknown Han Chinese census-lakers. Some intprovenlent is needed in this system: at the least, birth and death registers should be kept, verbal autopsies collected when a death occurs, and training and support given to those collecting the primary information. C o n t r o l o f i n f ' e c t i o u sa n d s a n i t a r y d r s e a s ei s n r o d e r a t ea t b c s t . T h e h i g h r a t e o f b r u c e l l o s i s r e p r e s e n t sa s e v e r e p u b l i c h e a l t l l p r o b l e u t . H o w e v e r , s i n c e t h e E p i d e r n i o l o g y C e n t r e officials were not forthcoming with intbrmation, liave not rnade significant improvements i n t h e s a n i t a t i o no f t h e i r o w n l o c a l t o w n ( d e s p i t et h e p o s s e s s i o no f v e r y a d v a n c e df o o d a n d water testrng equipment), and have not requested outside help, the prospects for itnprovenlents in this area seellr renrote. Further research could reveal to what extent the poor sanitary condition of the town is creating a hazard to the surrounding nornadic e n c a n r p r ) ) e n tasn d t o w n s h i p s . 6. 5. 3. I I EALT'II S y S7'EllI R EV I Ely u Y F-ACI LI'l'l' : I N F RA ST R U CTU R E, ACT|VITIES, AND KNOIYLEDGE, AT-IITUDES & PRACTICES l. Hospitrl O f t h e 1 5 8 [ ' > H Bs t a f f i n H o n g y L r a n ,6 4 w o r k a t t h c l ) e o p ] e ' s C o u n t y H o s p i t a l , a W e s t e r n l n e d i c a ll a c i l i t y w i t h r e p r e s e n t a t i o n b y C h i n e s et r a d i t i o n a l n r e d i c i n e .T h e n u n r b e ro f d o c t o r s l n - p o s t , t w e n t y - s e v e n ,i s g e n e r o u sb y a n y s t a n d a r dl b r t l r i s s i z e p o p u l a t i o n . A l l t h e n r a j o r s p e c i a l i t i e sa r e r e p r e s e n t e d a , lthoughapparrentlo y nly six of the doctors are fully university t r a i n e d . A t t h e t i n l e o f t h e s u r v e y , 1 6 % o f t h e p o s t e d c l o c t o r sw e r e o u t o f H o n g y u a n f o r 'l'he a d v a n c e dt r e i n i n g , w h i c h a l s o s e e n ) e da l a r g e p r o p o r t i t l n . n u r n b e r o f n u r s e s ,e i g h t e e n , i s i n s u f f i c i e n t l b r a h o s p i t a l o f t h i s s i z e , a n d t h e g r e a t e r n u n r b e r o f d o c t o r s s u g g e s t st h a t p r i o r i t y i s g i v c n t o s p e c i a l i s tk n o w l e d g e a n d n o t t o p r a c t i c a lp a t i e n t c a r e . Outpatient clinics are conducted in medicine, paediatrics,obstetrics and gynaecology, Chinese tradilional ntedicine (rnainly acupuncture and electrostirlulation, tlie only p h y s i o t h e r a p ya p p a r e n t l y a v a i l a b ) e ) , b u t o n l y 2 , 0 0 0 p a t i e n t s l r r e s e e n n t o n t h l y . C i v e n a p o p u l a t i o n o f 3 t , 0 0 0 , t h i s s u g g e s t so n l v e r a g e t h r e e v i s i t s t o t h c h o s p i t a l O P D e v e r y f o u r y e a r s . T h e n u r n b e r o f p a t i e n t s s e e n b y e a c h c l i n i c i s r e c o r d e d , b L l t t h e d i a g n o s i so f t h e p a t i e n t s ,o r a n y o f t h e i r p e r s o n a li n t b r r D a t i o n( e t h n i c i t y , a g e r s c x , t o w n s h i p ) i s n o t a p a r t o f a n y p e r m a n e n t r e c o r d , r e p o r t e d l y . H o w e v e r , w e w e r e t o l d t h a t 8 0 o / oo f o u t p a t i e n t ss e e n w e r e f r o t n t h e t o w n s h i p a r e a s( w h i c h i n f b r n r a t i o nw o u l d n o t h a v e b e e n p o s s i b l et o o b t a i n i f p e r s o n a l i n f o r m a t i o n w e r e n o t r e c o r d e d s o n r e w h e r e ) .T h e h i s t o r y , e x a r n i n a t i o n ,d i a g n o s i s a n d t r e a t r ) r e n tg i v e n t o t h e p a t i c n t i s r e p o r t e d l y r e c o r d e d o n t h e H o s p i t a l p h a r r n a c y p r e s c r i p t i o n ,w h i c h i s r c t a i n c d i n t h e P h a r r l a c y f o r o n e y e a r a n d t h c n t h r o w n o u t . T h e r e i s n o o t h e r p c n u a n e n t r c c o r d o f t h e p a t i e n t s 'c a r e k e p t e i t h c r b y t h c H o s p i t a l o r t h c p a t i e n r s t h e m s e l v e s .T h i s w a s r e c o g n i s c ' cbly t h e H o s p i t a l d i r e c t o r i r s a s e r i o u sc l c l l c i t . I n p a t i e n t s t i t t i s t i c a lr c c o r d s a r e r a t h e r b e t t e r . T h e n u r n b e r o f a d r D i s s i o n sf o r e a c h d i a g n o s i s , the nuniber and type of operation, the nuutbcr and type of dclivery, and the number and cause of inpatient deaths are recorded; however, we wDre not shown this inforntation. A v e r a g e s t a y i D e a c h o f t h e f i f t y b e d s w a s e i g h t d a y s , w i t h a b e d u t i l i s a t i o n r . , t t eo f 5 l % o , w h i c h s L r g g c s t sh a t t h e i n p a t i e r )i ti l c i l i t i e sa r e n o t u n d e r - u t i l i s e (dK i e l u r a n ne t . a l . , l 9 9 l ) .
-68-
Chargesfor outpatientand inpatientserviceswere flat rate and nrodest(10.6 RMB for an OPD visit, 18.6 RMB for an inpatientday, includingall procedures and medicines), and this may accountfor the fact that the Hospitalonly has a reportednet incomeof 90,000 RMB/yearto spendon trainingandequipment. The team'sdetailedreviewof thefacilityand its equiprnent can be fbundin AppendixE. In general,the buildingswereold, but keptcleanand in nrostlygood repair.Outpatient clinic and inpatientroom spacewas nrorethan adequate.The only outpatientequipmentnotedto be absentwas an adequatenumberof otoscopes. Althoughthe HospitalDirectorwas at painsto pointout manyold or dysfunctional pieces of equipment,only a few are really needingreplacement;most possiblycould be repaired, or have parts replaced.The X-ray machinein use as a fluoroscopewas dangerous:thc centralray was directedthrougha standingpatientonto a thin flLrorescent screen,behinti which the radio techniciansat. No personalfilrn badgesappearto be worn by X-rav personnel, department and if useof this pieceof equiprnent continues, a regularuseris ar high risk of damageto theol)ticallens,and of developnentleukaernia or anotherradiationcarrsedcancer. Equipnrent which conceivably ncedsattentionstrict.lyon the basisof its functionalstatus. afterinspcction, includes: l. Rentovalof a flrrorescent screenand placenrent of a PhotomLrltiplier unit and x-ray tube for 500 Ma fluoroscope(renrovethe dangerous40 Ma tluoroscope) 2. Repairor replacernent of 3 channelECC rnachine 3. Replacetransducerof real time Ultrasoundmachine 4. Repairor replacelaboratoryrefrigerator operatingtheatrelight 5. Replace In addition, severalpiecesof equiprnentwould seernto be standardfor a hospitalin a rurll locationsuchas this,andrvouldbe advisable for this Hospitalto oblain.Theseinclude: (anrbubag, perhaps J. Basicresuscitation equiprnent a Bird verrtilator) 2. Oneadditionalgoodqualityotoscope for OPD 3. Vendeuse suctionobstetric apparatus 4. EMO ethernebulizerfor operatingtheatre. With the aboveexceptions, in every area that the team visited,the nuntberand type ol' equipmentobserved, and the stateof the buildings,seenred appropriate to a hospitalof this ievel and in sucha location.The laboratoryarea had tunctionalequipnrent for the main important biochemicaland bacteriologicalanalysesdone in general rural hospitals.Tlr.: surgicaldepartment's equipmentwas sonrewhat linrited,but considering the fact that onlt' an averageof 0.54 proceduresper day are performedthere (despitethe presenceof seven eagersurgeons),this seemedadequate as well. 2. Women & Children'sClinic Although the visit to this HongyuanTown facility is reviewedin AppendixE, ir is
-69